|Publication number||US5968046 A|
|Application number||US 09/090,117|
|Publication date||Oct 19, 1999|
|Filing date||Jun 4, 1998|
|Priority date||Jun 4, 1998|
|Also published as||CA2331900A1, CA2331900C, DE69912600D1, DE69912600T2, EP1083837A1, EP1083837B1, WO1999062419A1|
|Publication number||090117, 09090117, US 5968046 A, US 5968046A, US-A-5968046, US5968046 A, US5968046A|
|Original Assignee||Smith & Nephew, Inc.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (5), Non-Patent Citations (2), Referenced by (146), Classifications (9), Legal Events (4)|
|External Links: USPTO, USPTO Assignment, Espacenet|
1. Field of the Invention
The present invention relates to a method and apparatus for reducing a patient's fractured bone using an elongated bone plate that has a plurality of openings therethrough, the openings having countersunk portions that correspond in shape to the countersunk head portion of a bone screw used to affix the bone plate to the patient's tissue and improved provisional fixation pins that preliminarily affix the plate in a selected position. Even more particularly, the present invention relates to an improved method and apparatus for reducing a patient's fractured bone at a fracture site wherein provisional fixation pins are used to preliminarily position the bone plate prior to permanent attachment with bone screws, each provisional fixation pin featuring a lower drilling tip portion and an enlarged diameter middle section having a surface that fits the countersunk openings of the bone plate. The lower drilling tip portion is smaller in diameter than the final bone screws to be used for permanent affixation.
2. General Background of the Invention
Bone plates have long been used to reduce and stabilize a patient's fractured bone at a fracture site. Bone plates are often shaped to conform to the patient's bone, having a concave rear surface shaped to fit a long bone of the leg or arm. Presently, many bone plates provide openings that include countersunk surfaces that are sized and shaped to conform to the countersunk head bone screws used to attach the bone plate to the patient's bone tissue.
One of the problems with the placement of a bone plate during surgery is that the bone screws used in cooperation with the plate typically have a diameter and distal tip that are imprecise when trying to perfectly place the screw. Often times, the surgeon misplaces a bone screw by a millimeter or two so that the plate is misaligned when all of the bone screws are finally implanted through the bone plate and into the patient's underlying bone tissue. This problem of preliminary fixation of bone plates has been recognized in the art.
Bone clamps are the standard method of provisionally attaching a plate to the bone prior to placing the bone screws through the plate. At least one spinal cervical plate for use in vertebral interbody fusions provides series of smaller holes in addition to the larger screw holes. These smaller holes accept pins that temporarily position the plate prior to placement of the larger bone screws. Clamps are not practical in the cervical area of the body. The limitations of these pins, however, is that they have no threads and must be driven in. This dictates that such pins can only be used to position the plate and not to hold the fracture reduced (i.e., hold the bone to the plate along the axis of the pin). In the case of a comminuted fracture with small bone fragments, attempting to drive the pins in instead of screwing them in may further displace the fragment from the plate.
There has been some discussion of standard bone plates with smaller holes similar to those in the spinal plates. These holes are used with standard K-Wires that have no shoulder and only position the plate, not affix it to the bone. Another draw back to this prior art methods is that it requires a special corresponding plate with small holes to accommodate the pins and cannot be used with standard bone plates.
One patent that discusses fixation pins for small bone fragments is the Pennig Pat. No. 5,433,719, entitled "Fixation Pin For Small-Bone Fragments". The '719 patent contemplates an implantable fixation pin for retaining small bone fragments in an osteosynthesis procedure. The pin comprises a smooth-walled shank portion and an adjoining threaded portion, wherein a step-down conical shoulder is formed between the shank portion and the threaded portion.
The Hausman Pat. No. 5,676,667 discloses a fixation plate for fixing the position of a fractured bone. The plate includes an elongated rigid plate having a plurality of first aperture spaced along the length of the plate. The first apertures are arranged and sized to receive threaded fasteners for fastening the plate to the bone on both sides of the fracture. The fixation plate also includes a plurality of second apertures spaced along the length of the plate. The second apertures, which are smaller than the first apertures, are arranged and sized to receive tacks to temporarily attach the plate to the bone on both sides of the fracture.
A publication that discusses the reduction of bone using plates and illustrates bone clamps is the Smith & Nephew Orthopaedics Information Catalog entitled "Aline™ Anterior Cervical Plating System".
The present invention is directed to a device that temporarily (provisionally) affixes a bone plate to the bone prior to the installation of the permanent attachment method, such as bone screws that will maintain some reduction without significantly comprising the bone.
The present invention thus provides a method of reducing a patient's fractured bone at a fracture site by preliminarily positioning a bone plate at the fracture site and at a selected provisional position.
The bone plate has a plurality of countersunk surfaces next to openings that receives bone screws such as the type that are commercially available having countersunk head portions.
The bone plate is secured to the patient's bone tissue at the fracture site with a plurality of provisional fixation pins.
Each of the fixation pins has a threaded distal end portion that passes through a selected opening in the bone plate and into underlying bone tissue.
The provisional fixation pins each provide an enlarged diameter portion having a surface that is shaped to fit the countersunk surfaces of the openings in the bone plate. Each of the provisional fixation pins has an upper unthreaded proximal section that can be attached to a driver such as a drill or like driver tool instrument.
The plurality of fixation pins are used to preliminarily hold the bone plate in a preliminary position. This enables a surgeon to confirm that placement is proper before permanently affixing the bone plate with bone screws.
The provisional fixation pin and its enlarged diameter section with the countersunk surface maintains some reduction without significantly comprising the bone. The lower end portion of the provisional fixation pin is relatively small in diameter, having a diameter that is smaller than the diameter of the shank of the bone screw that will eventually permanently attach the bone plate to the bone tissue.
With the method of the present invention, each provisional fixation pin is removed once plate position is proper. A bone screw is then implanted at the same location and in the same "pilot hole" formed by the provisional fixation pin.
A plurality of provisional fixation pins hold the bone plate in position. They maintain that position while the surgeon inserts conventional bone screws into openings of the plate that are not occupied. Once the plate is firmly and permanently anchored with conventional bone screws, the fixation pins can be removed one at a time and replaced with bone screws.
The present invention thus provides an improved bone plate apparatus for repairing a patient's fractured bone at the fracture site.
The apparatus includes a bone plate having upper and lower surfaces and a plurality of openings that include countersunk surfaces. These openings extend through the bone plate, the countersunk surfaces communicating with the upper or proximal surface of the bone plate.
A plurality of provisional bone pins are provided that respectively fit the plurality of openings, each bone pin having a threaded distal section with a drilling tip and a proximal section. An enlarged diameter section is positioned in between the proximal and distal sections.
The enlarged diameter section can include a convex annular surface that closely conforms in size and shape to the countersunk surface of each opening through the bone plate.
A plurality of larger diameter bone screws replace the provisional fixation pins, each bone screw having a head and a threaded shank. The diameter of the threaded shank is larger than the diameter of the distal section of the provisional bone pin.
The head of each bone screw is about the same diameter as the enlarged diameter section of the provisional bone pin.
For a further understanding of the nature, objects, and advantages of the present invention, reference should be had to the following detailed description, read in conjunction with the following drawings, wherein like reference numerals denote like elements and wherein:
FIG. 1 is a perspective of the preferred embodiment of the apparatus of the present invention;
FIG. 2 is a partial perspective view of the preferred embodiment of the apparatus of the present invention;
FIG. 3 is a sectional view taken along lines 3--3 of FIG. 2;
FIG. 4 is a sectional view taken along lines 4--4 of FIG. 2;
FIG. 5 is a partial elevational view of the preferred embodiment of the apparatus of the present invention;
FIG. 6 is a distal view taken along lines 6--6 of FIG. 5;
FIG. 7 is a fragmentary partial section elevational view illustrating the method and apparatus of the present invention;
FIG. 8 is a perspective view of the preferred embodiment of the apparatus of the present invention, and illustrating the first step of the method of the present invention;
FIG. 9 is a perspective view of the preferred embodiment of the apparatus of the present invention, and illustrating the second step of the method of the present invention;
FIG. 10 is a perspective view of the preferred embodiment of the apparatus of the present invention illustrating the third step of the method of the present invention; and
FIG. 11 is a perspective view of the preferred embodiment of the apparatus of the present invention, and illustrating the fourth step of the method of the present invention.
FIGS. 1-7 show the preferred embodiment of the apparatus of the present invention designated generally by the numeral 10 in FIGS. 1 and 7. In FIG. 1, provisional fixation apparatus 10 is shown at a fracture site 22 in patient's bone tissue 20. The bone tissue 20 includes segments 21A, 21B on opposite sides of fracture 22.
A drill 11 having a drill chuck 12 is used to insert a provisional fixation pin 13. In FIG. 1, the provisional fixation pin 13 includes an upper or proximal section 17 that is unthreaded, an enlarged diameter middle section 16, and a lower or distal section 15 having cutting tip 14. In FIGS. 1, 5, and 6, the provisional fixation pin 13 has a distal section 15 that is externally threaded. Cutting tip 14 can include three flat surfaces 14A and three cutting blades 14B.
During placement of the provisional fixation pin 13, the drill 11 and drill chuck 12 rotate in the direction of curved arrow 18 so that the cutting tip 14 cuts into the underlying bone tissue 20 embedding the externally threaded distal section 15 as shown in FIG. 7.
The provisional fixation pin 13 provides a lower externally threaded distal section 15 of a smaller diameter that is much smaller in diameter than the diameter D of the circular openings 14 in bone plate 19. In FIGS. 2-4, bone plate 19 has end portions 23, 24. In FIG. 4, a sectional view of bone plate 19 shows that there are a plurality of openings 25-30, each of which includes a circular opening 34 and a countersunk surface portion 33. The diameter D shown in FIG. 4 is of a diameter of 7 mm for example, while the diameter of external threaded distal section 15 is about 1.5 mm in diameter. This smaller diameter enables the surgeon to provisionally affix the bone plate 19 to the underlying tissue 20 without invading the bone tissue with a very large opening such as is formed by a conventional bone screw 39 having a shank diameter closely approaching the diameter "D" of opening 34 in FIG. 4.
Each of the openings 25-30 of bone plate 19 will eventually be occupied by a bone screw 39 having a countersunk head 40 portion. Prior to the placement of bone screws 39, the provisional fixation pins 13 of the present invention enable some reduction without significantly compromising the underlying bone tissue 20.
Bone plate 19 has end portions 23 and 24. The bone plate 19 also provides an inner concave surface 31 and an outer convex surface 32. Each of the openings 25-30 includes the circular opening 34 that communicates with both the upper convex surface 32 and the lower concave surface 31. The countersunk portion 33 communicates only with the upper convex surface 32. During use, both the provisional fixation pin 13 and a bone screw will preferably track the path of central axis 35 of opening 28 (see FIG. 4) or the central axis of any of the other selected openings 25-30.
In FIG. 5, the enlarged diameter section 16 of provisional fixation pin 13 has a lower convexly shaped annular surface 36. In FIG. 7, surface 36 conforms to and fits surface 33 of bone plate 19. Annular line 37 defines a border in between the lower annular surface 36 and upper annular surface 38 of enlarged diameter section 16.
In FIGS. 8-11, the method of the present invention is shown. The bone plate 19 has been placed in a provisional selected position at fracture site 22. In FIG. 8, five of the openings 25, 26, 28, 29, and 30 are unoccupied. In this position, two of the openings 27 and 28 are next to but on opposite sides of the fracture site 22 as shown. A single provisional fixation pin 13 has been inserted by rotating the pin 13 in the direction of arrow 18. Rotation continues until the large diameter section 16 occupies the opening 27, the annular surface 36 abutting and conforming to the countersunk surface 33 of the selected bone plate opening 25, 26, 27, 28, 29, 30.
The following table lists the parts numbers and parts descriptions as used herein and in the drawings attached hereto.
______________________________________PARTS LISTPart Number Description______________________________________10 provisional fixation apparatus11 drill12 drill chuck13 provisional fixation pin14 drill distal tip14A flat surface14B cutting edge15 externally threaded distal section16 enlarged section17 unthreaded proximal section18 curved arrow19 bone plate20 patient's bone tissue21A bone segment21B bone segment22 fracture site23 end portion24 end portion25 opening26 opening27 opening28 opening29 opening30 opening31 concave surface32 convex surface33 countersunk surface34 circular opening35 central axis36 lower annular surface37 annular line38 upper annular surface39 bone screw40 head______________________________________
The foregoing embodiments are presented by way of example only; the scope of the present invention is to be limited only by the following claims.
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|International Classification||A61B17/86, A61B17/80, A61B17/58|
|Cooperative Classification||A61B17/80, A61B17/8625, A61B17/8605|
|European Classification||A61B17/86B, A61B17/86A|
|Jun 4, 1998||AS||Assignment|
Owner name: SMITH & NEPHEW, INC., TENNESSEE
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:CASTLEMAN, DAVID;REEL/FRAME:009221/0159
Effective date: 19980520
|Mar 24, 2003||FPAY||Fee payment|
Year of fee payment: 4
|Mar 23, 2007||FPAY||Fee payment|
Year of fee payment: 8
|Mar 24, 2011||FPAY||Fee payment|
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